If you’re among the 10 percent to 15 percent of Americans who live with Irritable Bowel Syndrome (IBS), you know how debilitating it can be. Symptoms such as cramping, abdominal pain, bloating, gas, diarrhea, or constipation (or both) can severely compromise your quality of life. Fortunately, we have a growing array of tools in our arsenal — from diet and lifestyle changes to medication — that can help you manage these symptoms so that IBS doesn’t keep you from doing the things you love to do.
Before I go farther, I want to note that it’s important to differentiate Irritable Bowel Syndrome (IBS) from Inflammatory Bowel Disease (IBD)—an umbrella term describing inflammatory disorders of the digestive tract such as ulcerative colitis and Crohn’s disease—since the two can share symptoms and are often confused.
IBD can lead to life-threatening conditions, cause permanent damage to your intestines, and increase your risk for colon cancer, so it’s important to get an accurate diagnosis. If you are experiencing abdominal pain at least once per week related to your bowel habits, talk with your primary care physician, who may refer you to a gastroenterologist. Symptoms of IBD may include anemia, rectal bleeding, dark-black stool, weight loss, and fever, which warrant immediate medical attention. The traditional diagnostic tool for IBD is endoscopy (in which a flexible tube with a light and camera attached to it takes pictures of your digestive tract).
We don’t know exactly what causes IBS, but diet and stress can be significant aggravators. To diagnose IBS, gastroenterologists rely on a complete medical history, physical exam, blood and stool tests, and possibly endoscopic and imaging tests to rule out other diseases.
There are four different subtypes of IBS: with diarrhea; with constipation; mixed; or unclassified. Your doctor will determine which type you have and develop the most effective treatment plan to manage your symptoms.
Treating IBS Through Diet
Basic dietary modifications are the first line of treatment. I ask patients to tell me what they eat in a week and how their body reacts. Keeping a food and stool diary and sharing that during your initial visit can help pinpoint food triggers.
Fiber supplementation has been shown to help with symptom management for all IBS types, not just IBS with constipation. For many of my patients, I recommend an over-the-counter Psyllium-based fiber supplement, which is soluble and easier to tolerate.
Hydration is also important. I tell patients to watch their caffeine and alcohol intake, which can cause bloating and irritation in the gastrointestinal tract. Water, not juice or soda, should be your main source of hydration (about 64 ounces or eight servings per day).
I also advise my patients to avoid foods high in fat and sugars. Avoidance of gas-producing foods (beans, broccoli, cabbage, etc.) and dairy products that contain lactose can also help decrease IBS symptoms, especially bloating and diarrhea.
If my patients don’t get relief through these initial changes, I sometimes recommend more intensive dietary changes. Recent research has shown that a diet low in fermentable carbohydrates known as FODMAPS (fermentable, oligo-, di-, mono-saccharides and polyol) can improve symptoms. The goal of a low-FODMAP diet is to decrease the amount of gas-producing foods (dairy, beans, gluten, etc.) that you eat initially. As you get relief, slowly reintroduce food by groups to gain a better understanding of your food triggers and the GI symptoms certain foods cause.
The low-FODMAP diet is not meant to be a permanent intervention, but rather a tool to help you better understand what foods aggravate your IBS symptoms. For example, you might learn that eating dairy products exacerbates your IBS symptoms. You can then choose to avoid dairy products entirely or limit them in your diet. The low-FODMAP diet may not work for everyone. Diet is always a balance, and I often refer patients with IBS who are interested in following a low-FODMAP diet to a nutritionist.
Many of my patients ask about probiotic supplements, and there has been a lot of recent research on the gut microbiome or “good” bacteria in the gut. While some studies show probiotics can improve symptoms like flatulence, the research to date is not rigorous nor the findings consistent. Although some patients may benefit from a trial of probiotic supplementation, I tell my patients your nutrition has a greater effect on your microbiome: “You are what you eat.” Eating a healthy, low-fat diet and avoiding processed foods and sugars will promote a healthy gut microbiome better than a supplement can.
Treating IBS Through Stress Management
The brain-gut connection is real. Your gastrointestinal tract has millions of neurons, all mediated by the brain. It has been shown that people with IBS may have hypersensitive nerve endings in their gut, allowing bowel distension and bloating to trigger symptoms such as cramping and diarrhea. Often, IBS sufferers may have other chronic pain issues, and we see IBS more often in people who have anxiety and depression. When people experience anxiety, stress, and depression, these conditions can alter what is happening in the neurons in both your brain and your gut. Stress doesn’t cause IBS, but it may aggravate your symptoms.
It is vital to control your stress if you have IBS. Understanding what is causing your stress and how to reduce it is crucial. To help my patients control stress and anxiety, I recommend regular exercise. Exercise can help improve gut motility and studies show it can help with overall symptom improvement in IBS. Yoga and meditation are also excellent tools to relieve stress.
Don’t Ignore Your Symptoms
If your IBS symptoms remain severe despite lifestyle and dietary changes, then you may benefit from prescription medications. Treatment should be based on the predominant symptoms and subtype. Some drug interventions can result in complicated side effects, so it’s important to make sure any drug regimen you embark upon is being managed by your doctor.
If you do suffer from depression or anxiety, you should have an open line of communication between members of your care team. Some antidepressant medications that are used to treat depression and anxiety may also help with symptoms of IBS.
Too many people ignore the symptoms of IBS, and instead just try to live with it. Don’t fall into that trap. There are many fairly simple steps you can take, from changes in diet to stress management, that can significantly improve your quality of life. Talk to your doctor to find out what you can do to start feeling better today.
To learn more about IBS, including how to differentiate it from IBD, visit the Crohn’s and Colitis Foundation website.
Alexander Jow, MD, is a gastroenterologist with the Mid-Atlantic Permanente Medical Group. He sees patients at Kaiser Permanente’s Falls Church and Springfield Medical Centers and he offers patients care by video, phone, and secure message.
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